Provider First Line Business Practice Location Address:
12 RIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTROSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18801-1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-278-9458
Provider Business Practice Location Address Fax Number:
570-586-2196
Provider Enumeration Date:
01/24/2006